Big plan to save private practices

GOING UNDER: PATIENTS DRY UP DURING LOCKDOWN

‘Private-sector practitioners are essential against fight against Covid-19.’

The lockdown has claimed casualties whose role is crucial in the fight against the coronavirus, say private medical practitioners. Faced with a 60% decline in patient numbers, cash flow challenges and concern at being shunned by the public healthcare system – despite showing willingness to join forces in the fight against Covid-19 – private medical practitioners have come up with a fresh plan to mitigate the risk of closure of many practices.

Medical professional organisations are calling for the mobilisation of the country’s healthcare resources and health workers to effectively deal with the devastating plague.

At the forefront of the all-inclusive campaign against the coronavirus is the Progressive Health Forum (PHF), the South African Medical Association (Sama), South African Private Practitioners Forum (SAPPF), South African Medical and Dental Practitioners (SAMDP), Radiological Society of South Africa (RSSA) and the Independent Practitioner Associations Foundation (IPAF), which have insisted that only an integrated public and private sector approach could provide the best healthcare response to the coronavirus challenge.

The PHF – a national advocacy network – expressed concern at the public healthcare response to the pandemic.

Dr Aslam Dasoo of PHF said despite private medical practitioners having pledged solidarity with public healthcare professionals, the overture “elicited little traction from government”.

Dasoo said: “When it became clear that the private healthcare system which, in several respects, exceeds the capacity of the public, was not being meaningfully engaged by the authorities, despite the obvious necessity, PHF initiated a process to forge collaboration among clinicians in both sectors to address the pandemic.”

Dasoo said private practitioners faced dwindling patient numbers and “limitations on hospital admissions and surgical procedures [which] puts the ... viability of practices in serious doubt.

“The stark reality that otherwise viable practices will close is of great concern, because it will impact on the Covid-19 response.”

The PHF has unveiled an initiative to eliminate the risk faced by private medical practitioners.

According to PHF member Professor Alex van den Heever of the Wits School of Governance, the proposal envisaged private medical scheme funding for practices on “a capitation basis that would guarantee sufficient income for practices for the next 18 to 24 months, while capping the risk to medical schemes”.

Other key features of the proposal include:

Money being advanced by medical schemes to private practitioners on a nonrepayment basis, based on 2019 earnings, involving a guaranteed payment to medical practices of up to 70% of historical claims and 30% based on activities that exceed the 70%. The payment would be offset against activities as they normalised.

The global cap being based on both medical savings accounts and risk benefit claims, with medical, dental and allied practices also being supported.

Claims activities over 2020 and 2021 being capped at 2019 levels.

Dasoo said the framework reduced uncertainty for practitioners and medical schemes over periods of greatest risk.

Discussions with major health funders on the proposals “have been generally positive and barring any regulatory impediments, would be supported”.

He continued: “While we are confident that the proposal falls within the confines of the Medical Schemes Act, we have consulted the Council for Medical Schemes to fully address any potential regulatory concerns.

“In addition, we have consulted National Treasury in the context of the economic implications of the financial distress of medical practitioners and possible knock-on effect.

“Issues raised by all parties have been incorporated into the proposed framework.”

The adoption of the proposal, would ensure that private practices “retain a degree of resilience that will enable them to support government in addressing the pandemic”.

Sama Gauteng chair Dr Mark Human said private practices had seen a 60% decline in patient numbers during lockdown, with some specialists shutting down “due to the high risk of infection”.

“During Level 3, patient numbers have increased, but are still 40% to 50% lower than normal, putting tremendous strain on practices’ ability to survive in the short and medium term,” said Human. –

National Treasury and Council for Medical Schemes consulted